急性孤立性脑桥梗死神经功能缺损进展的危险因素分析

目的 探讨急性孤立性脑桥梗死（acute isolated pontine infarction，AIPI）神经功能缺损进展的危险 因素、病因分型及预后。 方法 回顾性分析2015年1月-2018年6月在西安交通大学第二附属医院神经内科住院的AIPI患者临 床资料，根据其是否存在神经功能缺损进展，将患者分为进展组与非进展组。记录两组患者一般资 料、病因分型、椎-基底动脉延长扩张症（vertebrobasilar dolichoectasia，VBD）的发生率及预后，通过多 元逻辑回归分析确定AIPI神经功能缺损进展的危险因素。 结果 最终纳入122例AIPI患者，进展组28例（23.0%），非进展组94例（77.0%）。进展组在糖尿病 患病率、入院时吞咽障碍发生率及出院时mRS评分均高于非进展组，差异具有统计学意义。进展组 病因分型中基底动脉分支动脉疾病（basilar artery branch disease，BABD）有16例（57.1%），小动脉疾病 （small artery disease，SAD）有2例（7.1%），大动脉闭塞性疾病（large artery occlusive disease，LAOD）有 10例（35.7%），进展组与非进展组差异有统计学意义（χ 2=8.739，P =0.013）。进展组VBD的发生率为 25.0%（7/28），高于非进展组的13.8%（13/94），但两组比较差异无统计学意义（P =0.267）。相比非 进展组，进展组不良预后比例显著增加（46.4% vs 10.6%，P <0.001）。Logistic回归分析显示，吞咽障 碍是AIPI神经功能缺损进展的独立危险因素（OR 4.610，95%CI 1.461～14.546，P =0.009）。 结论 AIPI的患者，当存在糖尿病、吞咽障碍、VBD、病因分型BABD时可能更容易出现神经功能缺损 进展；吞咽障碍是AIPI神经功能缺损进展的独立危险因素；发生神经功能缺损进展的AIPI患者预后 不良的发生率增高。     

BTX-A注射唾液腺改善脑卒中流涎症的临床研究

目的 观察BTX-A注射唾液腺改善脑卒中流涎症的临床疗效和安全性。方法 收集福建中医药大学附属康复医院住院的30例脑卒中后流涎的患者,按照随机数字表法随机分为治疗组15例和对照组15例。两组均给予常规吞咽康复训练12周,治疗组在常规吞咽康复训练基础上予超声引导下100U BTX-A双侧腮腺和颌下腺分别注射35U及15U。采用流涎频率评分、教师流涎分级法(TDS)、Frenchay构音障碍评定法中关于流涎的分级标准于BTX-A治疗前、治疗12周后评估各组患者的流涎程度。结果 BTX-A注射唾液腺12周后,治疗组的流涎频率评分总有效率明显高于对照组的(P＜0.05)；治疗组TDS评分总有效率明显高于对照组的(P＜0.05)；治疗组Frenchay流涎评分总有效率明显高于对照组(P＜0.05)。结论 常规吞咽训练配合BTX-A注射唾液腺明显改善脑卒中吞咽障碍患者的流涎症状,是一种安全有效的治疗方法及副作用少,对改善患者形象及生活自信建立帮助巨大,值得临床上推广及应用。     

风三针治疗中风后吞咽障碍临床研究

目的:观察“风三针”针刺疗法在治疗中风后吞咽障碍的临床疗效。方法:随机收集中风后吞咽障碍患者60例,按照不同的治疗方法分为对照组和治疗组各30例。两组均先进行吞咽康复训练,后治疗组予风三针针刺治疗,观察两组治疗后洼田饮水试验评分,VFSS吞咽难度评分,并进行对比分析其临床疗效。结果:对照组及治疗组在治疗4个疗程后,治疗组总有效率93.33%高于对照组70.00%(P<0.05); 两组洼田饮水试验评分治疗后均低于治疗前(P<0.05),治疗组的评分低于对照组(P<0.05); 两组的VFSS吞咽难度评分治疗后均高于治疗前(P<0.05); 治疗组的VFSS难度评分高于对照组(P<0.05)。结论:“风三针”针刺疗法在治疗中风吞咽障碍中临床疗效确切。     

A new training method for velopharyngeal dysfunction: Self-inhalation for hypernasality

ObjectiveThere are various methods to treat velopharyngeal dysfunction including surgery and rehabilitation therapy. Even if a rehabilitation program is effective, the evaluation of its efficacy remains subjective. In this paper, we propose a new method of rehabilitation training for velopharyngeal dysfunction focusing on the objective peak inspiratory flow (PIF) rate.MethodsFour patients, who were diagnosed with velopharyngeal dysfunction without cleft palate at ENT clinic of the National Hospital Organization, Tokyo Medical Center, participated in this study. All patients underwent our original rehabilitation program for velopharyngeal dysfunction, a method using the In-Check Dial, Turbohaler model. As a self-training rehabilitation program, we asked them to inhale forcefully 10 times daily at home using the In-Check Dial to increase the value of PIF rate for 3 months. We measured the patients’ PIF rates with the In-Check Dial at the ENT clinic at the initial visit and after the 3-month training.ResultsThe PIF rates of the four patients without nasal clips were higher than the rates with nasal clips at the initial visit. After the training, PIF rate without a nasal clip of all patients increased than the rate at the initial visit, which represented significant difference (P < 0.05). Also, after 3 months, PIF rate without a nasal clip was higher or equal than the rates with a nasal clip at the initial visit except one case. Naso-pharyngo-laryngeal fiberscopy did not detect salivary pooling around larynx and mirror fogging test did not show nasal escape in the three of four patients after 3 months of training. All reported improvement in dysphagia and dysarthria.ConclusionThis new method can be used not only to evaluate velopharyngeal function but also as an effective self-training treatment.     

Functionally navigated transcranial magnetic stimulation to evoke lingual pressure in stroke survivors with dysphagia and healthy adults: a proof of concept trial

ABSTRACT

Background

Post-stroke dysphagia is characterized by reduced corticolingual excitability and lingual pressure; however, it remains unknown if transcranial magnetic stimulation (TMS) directly facilitates lingual pressure generation.     

针药结合治疗脑卒中后假性球麻痹吞咽障碍研究进展

吞咽障碍是脑卒中后常见的并发症之一,目前针药结合治疗本病具有较好的临床疗效。综述近年来针药结合治疗脑卒中后假性球麻痹吞咽障碍的文献,以期对本病未来的临床工作有些许启发。目前以针药结合为主治疗本病的方法包括毫针结合内服中药、穴位贴敷、穴位注射、中药穴位离子导入以及毫针与中药以其他形式的结合,包括中药药棒、药枕、中药点舌、氧驱雾化吸入、灌肠等。针药结合治疗本病具有同效相须、异效互补、反效制约的治疗特点,也存在不少问题亟待解决。     

First Japanese autopsy case showing LRRK2 mutation G2019S and TDP-43 proteinopathy

This is the first Japanese autopsy case of Leucine-rich repeat kinase 2 (LRRK2) G2019S mutation with atypical TDP43 proteinopathy. Our case is important that presented clinically dysphagia and pathologically TDP-43 proteinopathy. TDP43 may play an important role of clinical presentation with LRRK2 G2019S mutation carriers.